Last week, we stated that blood transfusions have been decreasing for the past seven years and are expected to increase slowly in the near future. A lower transfusion rate appears to be advantageous for recipients because a liberal transfusion policy has been associated with poorer outcomes including increased mortality, multiorgan failure, increased ICU and hospital stays.

Decreased demand for blood transfusion may ease the strain on blood centers and transfusion services because blood collections are expected to decrease in the future. The average age of blood donors is increasing. Donations of repeat donors 50 years and older has increased. Donors between the ages of 24 and 49 years are donating less, possibly because of decreased civic engagement. More than half of first time donors never donate again. With aging and illness, the older population of blood donors will eventually become recipients.

Today, the blood bank industry has a policy of blood safety at any cost. More blood screening tests are being added to detect increasingly rare infectious agents. This policy is well intentioned but may be economically irrational, because it decreases the number of eligible donors and increases the cost of transfusion. For example, screening blood donors for HTLV has been calculated to cost $59 million per QALY. The fully loaded cost of transfusing a surgical patient has been estimated to be $1148 per unit of blood.

The decision to screen blood donors often appears to be based on the availability of an approved screening test. Test availability is guided by manufacturer’s market & profit. We will need to rethink this policy, as health care dollars get tighter.

Eighteen of 23 studies have suggested that adverse effects are associated with transfusion of older blood. Red blood cells stored for more than 3 weeks lose their membrane flexibility. Three major clinical trials are in progress, which may determine if blood centers will need to supply fresher blood. For example, will cardiothoracic surgeons and critical care physicians demand blood less than 14 days old? Will it be necessary to decrease the shelf life of red blood cells from 42 to 21 days? If so, blood inventory management will become even more difficult.


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